Wiki True Hermaphrodite

[Jessim929]

Hi All -

I KNOW I can not possibly be the first or only coder with this issue, but it's a first for me. We have a 60 year old patient who is a true hermaphrodite. Has a phallus and small testes, but also menstruates and lactates. (Literally, she has ALL the parts.) Patient was seen (I code for Urology) for a scrotal mass. Diagnoses used on the claim by the doctor was N50.811 (right testicular pain & D29.31 (benign neo of right epididymis). Claim clearinghouse rejected the claim because patient identifies female. I added the true hermaphrodite diagnosis of Q99.1 -which, by all logic should override the remainder of the diagnoses. But it didn't. There's nothing else clinical that can be added - I discussed with the doctor. We can not get the claim to pass thru PayerPath, and I'm out of ideas. It's Medicare, so it's not like we can drop it to paper. Can anyone else shed light on how I can get this claim to pass edits? I can't exactly remove diagnoses, especially since the patient is scheduled for surgery at the end of the month.

Thank you!!

 

[cgaston]

Try adding the -KX modifier:

...the KX modifier should also be used to identify services that are gender specific (i.e., services that are considered female or male only) for effected beneficiaries on claims submitted by physicians and non-physician practitioners to Medicare carriers and MACs. Use of the KX modifier will alert the carrier/MAC that the physician/practitioner is performing a service on a patient for whom gender specific editing may apply, and that the service should be allowed to continue with normal processing. Payment will be made if the coverage and reporting criteria have been met for the service.

ETA: This is from the Medicare guidelines for transgender billing but I think it works in this case as well

 

[Jessim929]

That's only for procedures, not E&M... But don't think I didn't try that too!